CPT code 63267 is for a lumbar laminectomy to remove or evacuate an extradural intraspinal lesion that is not a tumor.
CPT code 63267 is used to describe a surgical procedure known as a laminectomy, specifically performed to remove or evacuate an intraspinal lesion that is not a tumor (neoplasm) and is located outside the dura mater (extradural) in the lumbar region of the spine. This procedure involves removing a portion of the vertebral bone called the lamina to access and address the lesion, which could be causing symptoms such as pain or neurological deficits. The goal is to relieve pressure on the spinal cord or nerves and improve the patient's condition.
For CPT code 63267, which involves a laminectomy for excision or evacuation of an intraspinal lesion other than a neoplasm, extradural, in the lumbar region, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed bilaterally, this modifier indicates that the procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: This is used when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures that are not normally reported together but are appropriate under the circumstances.
5. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are primary and each performs a distinct part of the procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: This is used when the same procedure is repeated by the same physician subsequent to the original procedure.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician than the one who originally performed it.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This is used when a patient requires a return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This indicates that an assistant surgeon was required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This is used when an assistant surgeon is required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Proper documentation is essential when using modifiers to justify their application.
The CPT code 63267 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates.
However, the actual reimbursement for CPT code 63267 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting local coverage determinations, which can influence whether and how much Medicare reimburses for this particular procedure.
Therefore, healthcare providers should consult their specific MAC for detailed information on reimbursement rates and any additional requirements that may apply to CPT code 63267.
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